Urinary incontinence causes clinical pictures

There are many causes that can lead to urinary incontinence. Incontinence can have various causes. Have manifestations. A distinction is made primarily between the two most common forms, stress incontinence and urge incontinence .

But also the less frequent clinical pictures, such as reflex incontinence and extraurethral incontinence or mixed forms, can become a plaguing burden for the patient.

Stress incontinence

Stress incontinence is the most common form in women, accounting for 35 to 45% of cases. When the prere in the urinary bladder increases, for example due to coughing, sneezing, running or climbing stairs, a disorder in the urethral closure occurs.

This form of incontinence is divided into three different degrees of severity:

– Involuntary leakage of urine during heavy physical exertion. These include bouncing, jumping, coughing,sneezing and heavy lifting. – Involuntary leakage of urine during light physical exertion such as climbing stairs, walking, standing up or sitting down. – Loss of urine even at rest without significant strain, but not when lying down (with Ingelmann-Sundberg)

Causes

The cause of stress incontinence is usually a weakness of the pelvic floor muscles and/or damage to the ligamentous apparatus, which is responsible, among other things, for the proper closure of the urethra. These disorders are triggered, for example, by the strong stretching of the pelvic floor muscles or. of the connective tie during pregnancy and/or birth or even the tearing of these tie structures. Other factors for overactive bladder are heavy physical work, overweight or obesity and chronic bronchitis in smokers. Descensus of organs in the pelvic region (uterine descent, vaginal descent) can also trigger stress incontinence. It is often accompanied by pelvic floor weakness.

Stress incontinence and pregnancy

Already during pregnancy, the increasing weight of the child can cause stretching and reduction of the pelvic floor muscles, so that this leads to stress incontinence in about 50% of all women. Usually the condition improves after birth. Incontinence persists in only 6% of all women.

Urge incontinence, overactive bladder (OAB)

A frequent, unsuppressible, strong (imperative) urge to urinate, combined with an involuntary loss of urine, are the hallmarks of urge incontinence. In Anglo-American-speaking countries, the term "wet overactive bladder" is used to refer to over-active bladder wet (OAB wet). In contrast, in the case of "OAB dry", the affected person does not feel the urge to urinate only the constant, unsuppressible urge to urinate, but manages to reach the toilet in time thanks to good pelvic floor muscles. Urine leakage does not occur. This unsuppressible urge to urinate is also described as urgency or irritable bladder.

Urge incontinence is the second most common form of incontinence in women. In about 20 to 40% of cases, straining occurs-. Urge incontinence combined on.

Causes

Many women struggle with urinary incontinence after childbirth.

An overactive bladder often occurs as a result of pregnancy, childbirth and especially old age. But it can also be caused by other diseases. It can be caused, for example, by inflammation of the urinary tract, or by ureteral or bladder stones. Also a lack of the female sex hormone estrogen, as it is typical after menopause, or tumors of the bladder or the ureter, can trigger the symptoms of urge incontinence. Other possible causes often have a neurological background, such as Parkinson's or Alzheimer's disease, nerve diseases, brain tumors or strokes.

Triggers of this symptom complex are often but also subsidence of the bladder and the uterus / vaginal region. Through lowering interventions, approx. 80% of overactive bladder disorders/incontinence are cured.

Reflex incontinence

With reflex incontinence, the affected person has no control over his urge to urinate. Emptying of the bladder can neither be started nor interrupted voluntarily. There is an underlying malformation or injury to nerve tracts, such as occurs in patients with paraplegia, severe disc herniation or open back (spina bifida).

Causes

The causes of reflex incontinence lie in malformations or injuries of the nerve pathways between the brain and the spinal cord, which are responsible for controlling the bladder function. This leads to complete loss of control of the brain over the bladder center. The bladder empties without the urge to urinate, as this mechanism is autonomous, i.e. without the possibility of influencing it.

Overflow incontinence

In overflow incontinence, the balance between bladder and urethral prere is disturbed. If the bladder is stretched too much and the prere in the bladder exceeds the prere in the urethra, the bladder overflows, so to speak. The urine flows out of the bladder unhindered until the prere between the bladder and the urethra is equalized. There is always a residual amount of urine left in the bladder (residual urine).

Causes

Reason for "overflow" is usually damage to the nerves in the bladder. This can be the case, for example, after extensive cancer surgery in the pelvic area. Further also bladder emptying disturbances by constrictions of the urethra or (rarely) a kink this can be cause for an overflow incontinence.

Extraurethral incontinence

Extraurethral incontinence is urine leakage through openings other than the urethra. It is also called absolute incontinence, which occurs due to congenital or acquired malformations.

Causes

The most frequent cause are so-called fistulas. They occur after inflammation or after gynecological surgery with an unnoticed injury to the bladder.

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